The problem of decubitus ulcers and blisters experienced by people suffering from foot-drop and other nonambulatory conditions is well documented. The primary cause of these ulcers is the immobility of the bedridden patient which causes an interruption in the flow of blood to capillaries in areas of the skin adjacent bone protuberances. The interruption of blood flow to the capillaries causes skin cells to die which results in a breakdown of skin tissue and the development of ulcers. The heel is an area particularly susceptible to decubitus ulcers.
Various ankle/foot orthoses and splints are known in the art for supporting, aligning and correcting foot deformities. For instance, a splint may he chosen for a severely sprained foot or ankle which protects and immobilizes the ankle joint in proper alignment to facilitate healing. Further, persons suffering from paralysis of the anterior leg muscles resulting in insufficient voluntary ankle dorsiflexion (commonly referred to as foot-drop) may select an ankle/foot orthosis which maintains the ankle joint in a neutral position and supports the toes while the person is bedridden and/or during walking. While these prior art splints and orthoses adequately support and align the ankle and/or foot, these devices do not address other problems frequently experienced by nonambulatory patients, or patients suffering from foot-drop and other ankle/foot ailments. Nor do these prior art devices provide access for treating (applying ointments or changing dressings) any ulcers without removing the splint/orthosis. Removing the splint/orthosis each time an ulcer is treated is a time consuming procedure and can he quite painful to these patients whose ankle regions are often aggravated and sore. Moreover, because these prior art devices are designed with the singular intention to physically support and align the ankle region, these splints and orthoses often directly contact and become adhered to the ulcerous area thereby irritating the wound.
Another problem with these prior art devices is that they fail to provide a convenient means for elevating the foot. Elevating an injured extremity is a proven technique to minimize swelling, increase blood circulation, and facilitate the healing process. Several of the prior art splints/orthoses include a mechanism to couple with a traction device thereby enabling elevation of the foot. It is also known to elevate the foot by placing pillows, towels, or books beneath the foot. However, neither of these prior art techniques are convenient for a non-ambulatory person. The former requires specialized traction equipment which is often unavailable except in a hospital setting. Further, spare pillows, books, towels, and other support materials may become undesirably soiled, can be uncomfortable unless care is taken to continuously adjust their positioning, and require a non-ambulatory patient to "ambulate" to fetch the materials or else receive constant attention from others.
In order to solve these and other problems in the prior art, the inventors herein have succeeded in designing and developing orthoses for supporting a patient's ankle in a neutral position while enabling access for treatment of ulcers on the heel or foot bottom. As used herein "orthosis" shall refer to any device employed to support or align the foot, to prevent or correct foot deformities, or to improve the functions of the foot. Orthoses specifically include splints. An orthosis according to a first embodiment of the present invention includes a generally "L" shaped frame which is fitted to a patient's foot and back ankle, and is secured with Velcro.RTM. hook and loop straps, tape, or other suitable securing means wrapped around the patient's leg. The frame includes at least one aperture located at the patient's heel such that access to this ulcer prominent region is not obstructed by the frame. A pivotally coupled cover over the aperture protects any ulcers on the heel from inadvertent contact when closed. By rotating the cover about its pivot, the cover may be swung open to expose the patient's heel thereby allowing treatment of the ulcer without disturbing the frame secured to the patient's leg. This eliminates the time consuming, and often painful, removal of the orthosis as required by the prior art to treat the ulcer. As used herein, "closed" shall refer to the cover positioned adjacent the aperture and "open" shall refer to the cover swung away from the aperture.
Moreover, a spring biased cover latch mounted to the frame allows the cover to be locked in an over-center open position for resting the patient's foot with the cover supporting it above any convenient resting surface, such as a bed. Special traction equipment and pillows/books are no longer necessary to elevate a patient's foot as with the prior art. Opening and closing the cover is easily performed by a patient by simply reaching down to the orthosis, operating the cover latch (to open), and rotating the cover about its pivot.
An orthosis according to another embodiment of the present invention includes a pivotally adjustable frame comprising a foot section and a calf section that are fitted to a patient's foot and calf regions, respectively, and are secured to the patient with Velcro.RTM. hook and loop straps or other suitable means wrapped around the patient's foot and calf regions. The foot section is pivotally coupled to the calf section so as to allow adjustment of a relative angle therebetween.
In this embodiment of the invention, a brace extends between the foot and calf sections for maintaining the relative angle in a fixed position, and for allowing adjustment of the orthosis to one of several predetermined positions. The brace is pivotally connected to the foot section and is adjustably connected to the calf section through an elongated slot extending through the brace and several eyelets disposed about the elongated slot. A latch extends through a bracket connected to the calf section, through the elongated slot, and through one of the eyelets when the latch is in a "locked" position so as to adjustably connect the brace to the calf section while maintaining the relative angle between the foot and calf sections in a fixed position and preventing collapse of the orthosis.
When an adjustment button is depressed, the latch is moved to an "unlock" position and can slide along the elongated slot to allow adjustment of the relative angle between the foot and calf sections. In an "upright" or approximately 90 degree position, the orthosis supports the patient's ankle in a neutral orientation while preventing inadvertent contact with the patient's heel. The foot section includes a heel portion that is configured to maintain positive clearance between the patient's heel and the foot section.
In a "fully reclined" position of the orthosis with the patient's leg in a generally horizontal position, the patient's heel and sole are exposed to allow treatment thereof without removing the orthosis from the patient's leg. Moreover, in the fully reclined position, the patient's leg can rest in the calf section with the foot section elevating the calf section, and the patient's leg and foot supported thereby, above any convenient resting surface. The orthosis can also be adjusted for comfort to positions intermediate the upright and fully reclined positions.
Thus, the present invention satisfies a long-felt need by providing an orthosis which can sturdily support an ankle while at the same time allowing heel and foot ulcers to be treated without removing the orthosis, and which provides a stable and convenient mechanism to elevate the foot. While the principal advantages and features of the present invention are briefly described above, a more thorough understanding and appreciation for the advantages and features of the invention may be obtained by referring to the drawings and descriptions of the preferred embodiments which follow.